Back Pain Balloon kyphoplasty Cervical plating Lumbar Fixation Lumbar Microdiscectomy Scoliosis Spinal Stenosis:Lumbar & Cervical Spondylolisthesis Send Your Query Lumbar Microdiscectomy by Dr.Shankar Acharya Normal disc anatomy The vertebral bones are separated by intervertebral discs. There are 23 articulating discs in a normal spinal column. Inter vertebral discs act as shock absorbers and prevent the bones from collapsing. Spinal discs are placed between the two vertebral bodies. The primary function of spinal discs are- • Acting as shock absorbers to prevent collapse of the vertebrae • To provide mobility to the vertebral segment • To provide stability to the vertebral segment • To provide height to the vertebral column Discs are made up two types of fibers : • Annulus Fibrous • Nucleus Pulposus Annulus fibrous forms the outer layer and is very strong in nature. On the other hand, the inner portion of the disc is formed by a soft jelly like structure called Nucleus Pulposus. With aging process the discs loose their water content and thus leading to wear and tear of the disc fibers. It is the inner layer i.e. nucleus pulposus that herniates out which is commonly known as Slipped disc. What is Disc herniation? Disc herniation means moving out of the disc from its normal position. What are the Causes of disc herniation? • Age related degeneration • Sedentary lifestyle and desk or computer jobs. • Sudden weight lifting. • Genetic Predisposition. What is Microdiscetomy? Discectomy (disc- washer; -ectomy is to remove) means removal of disc. If the protrotuded disc is removed through a microscope hence it is termed as Microdiscectomy. How is the microdiscectomy performed? • Microdiscectomy procedure requires a special microscope to view the internal structures like disc and Dura. It is performed under general anesthesia. The patient is made to lie in prone position. Cleaning and draping is done for the back. • A small open incision is made in the back according to the site of the disc herniation. A portion of bone is removed so as to provide more room for the nerve to heal and then through a microscope the disc bulge is removed. This removes the pressure over the nerve root and hence, alleviates the leg pain almost immediately. What are the advantages of Microdiscectomy surgery? • Minimaly Invasive procedure and hence small insicion on skin. • Cosmetically acceptable; as less damage to surrounding tissues. • It releases the pressure over the impinged nerve root thus the radiating pain is relieved immediately. • It has shorter hospital stay. • Quicker return to work and normal activities. • Patient can get up and walk the next day itself. Frequently Asked Questions Is it necessary to undergo the surgery immediately? Immediate spine surgery is only necessary in cases of : • Severe pain in legs affecting sleep and quality of life. • Weakness in legs • Bowel/bladder problems However, ideally the disc herniation should be done with in the first three months to have the optimum benefit. What are the Risks and Complications of the procedure? Generally it is a very safe and minimally invasive procedure but some complication may occur due to anesthesia and the surgery which are : • Pain, chest complication, nausea and vomiting due to the side effect of anesthesia. • Infection may occur as a complication. • Bleeding may occur from the incision site • Wound dehiscence. • Dural tear may occur leading to CSF leakage. • Bowel/bladder incontinence may occur. • Nerve root damage. However, the above complications for Microdiscectomy spine surgery are quite rarely seen in only 1-2% cases. How much incision will be left after surgery? It is a minimally invasive technique. Usually one- one and a half inches incisions is made at the back of the patient. Do I need to perform any test prior to surgery? Yes, there are a set of test known as PAC (Pre Anesthetic check up) that you are required to undergo before surgery so as to be declared FIT for surgery by the anesthesia team. Our team will guide you about how to undergo these tests. What is the success rate of this operation? Microdiscectomy surgery has a success rate of approximately 90% to 95%, although 5% to 10% of patients will develop a recurrent disc herniation at some point in the future. What will happen if I leave the disc untreated? Spinal deformity or list may occur along with: • Excessive pain due to further compression on the nerve roots • Bladder bowel or/and sexual dysfunction • Impaired gait, poor balance • Reduced quality of life Will I be paralyzed if I leave the disc as it is? No, paresis may occur leading to decrease in power and strength but complete paralysis rarely occur due to a disc herniation. How much will be the cost of the surgery? Usually the surgery will cost from 75,000 to 1.25 lakhs depending upon the type of room you take in the hospital. Does this procedure come under Insurance policy? Yes, for undergoing Microdiscetomy you can have your insurance cover. You can confirm the same once with our Admission desk/TPA desk. You can take along your insurance card and policy. Will the surgery be performed under local or general anesthesia? This procedure is generally done under general anesthesia. How much time is required for surgery? It takes around 45mins to 60mins to perform the surgery depending upon patient to patient. How much time do I need to stay in hospital? One day before surgery you need to be admitted in the hospital so as our team can perform the essential tests required before surgery. And you will be discharged on the 2nd or 3rd day depending upon your general health condition. Will it relief my pain immediately? Yes, the radicular pain that was coming to your leg would go almost immediately after the compression is relieved but your back pain may take 2-3 months to go off completely. What are the restrictions that I need to take following surgery? • Restriction from bending, lifting, or twisting for the first six weeks following surgery. • Proper wound care; keep the wound dry and clean. • Advised not to lift heavy objects for 12 weeks following the surgery. Do I need Post operative Rehabilitation or therapy? Yes you need to under go physical therapy under a trained physical therapist initially. The therapist will make you- • Perform the activities of daily living, for ex. lying to sitting; to stand. • General conditioning exercises. • Deep breathing exercises. • Gentle stretching exercises. • Understand the proper postural stability. Can I have bath after going back home? No, you have to keep the wound clean and dry so you can sponge yourself but you cannot bath. Once the stitches are removed after 2 weeks, next day you can take bath, with approval from your doctor. When do I have to come back post surgery? Usually you have to come after 2 weeks post surgery for stitch removal. Though you are required to see the surgeon immediately if any of the below mentioned symptoms may occur- • Fever • Any redness, swelling around the stitch area • Any drainage or blood oozing from stitch area • Severe backache. • Severe numbness or tingling in the legs Can I drive after surgery? Patients should not drive until they are given approval by their doctor. Normally you can drive 4-wheeler after 1month of surgery. Two wheelers need to be avoided strictly. When can I undergo the surgery? When you are mentally prepared for surgery, you can call and confirm the same to our team on the following numbers, so as to book the operation theatre and room for you. You will be provided the tentative date for admission and surgery.